Young and middle-aged whites in the Southern Central Valley are dying at an increasing rate, researchers said Wednesday at the release of a preliminary report that they said reveals a “health crisis of white death.”

The rising death rates of whites in the counties, among the poorest in the state, are preventable and are “driven by acts of despair: drug overdoses, chronic alcohol abuse and suicide,” they said.

An opioid epidemic is one factor in the increasing death rates – but not an overriding one, the researchers said.

“The deaths are occurring among a population struggling with unemployment, wage stagnation and poverty rates,” said Dr. Steven Woolf, lead author of the study and director of the Center on Society and Health at Virginia Commonwealth University. “The economy is literally costing lives.”

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The researchers said the study shows it is not the time to reduce access to health care and other social services in California.

The report for the California Endowment found that in four counties – Fresno, Kings, Tulare and Kern – the death rate for whites was almost 40 percent higher than the overall white death rate in California from 2010-14.

The deaths are occurring among a population struggling with unemployment, wage stagnation and poverty rates.

Dr. Steven Woolf, author of ‘An Epidemic of White Death: A Canary in the Coal Mine?’

The death rate for the four counties was 708 per 100,000 for people ages 40 to 64, compared with a state average of 512.

Woolf said he expects to find increased rates of deaths among whites in other counties in California and in rural white counties across the United States when the study is completed in March.

But the preliminary results from the four Valley counties are a “very ominous trend” in which the death rate among young and middle-aged non-Hispanic whites is increasing, he said.

The endowment chose to examine death rates for the four Valley counties because of the economic stress that residents are under and because Building Healthy Communities projects have been established in the region, said Dr. Anthony Iton, senior vice president with the endowment, which is the largest health foundation in the state.

Increasing death rates for whites have been getting increased attention nationally – death rates for Hispanics and African Americans have not been increasing. The Washington Post and the Economist have written about a connection between white mortality in counties and support for President-elect Donald Trump. Counties with high white mortality rates were found to support the president-elect.

Voting records for the Valley show that Kings, Tulare and Kern counties supported Trump, while Fresno County supported Hillary Clinton. But Iton said the endowment study did not involve voting patterns.

Valley counties, however, have been buffeted by economic stresses that have affected white working-class Americans, he said. The fact that young and middle-aged whites here are dying at increasing rates and Hispanic and African Americans are not says that “there’s something unique underlying this, and we think this needs to be explored,” Iton said.

The Valley is an impoverished region, said Sarah Reyes, a longtime Fresno resident and former member of the California Assembly who is head of the Building Healthy Communities initiative in Fresno. “It’s not just the poor Latino farmworkers, nor just the poor African Americans who may be living in southwest Fresno. It is everybody,” Reyes said.

“This Valley also has a lot of poor white people living in it who live in abject poverty, and they are feeling the stressors of not being able to get a job, of living in impoverished neighborhoods,” she said.

We’ve recognized for a long time if you had to describe what actually causes health in one word, that word would be hope.

Dr. Anthony Iton, senior vice president of Building Healthy Communities at The California Endowment

Iton suspects chronic stress is a factor in the increasing white death rates.

“We’ve recognized for a long time if you had to describe what actually causes health in one word, that word would be ‘hope,’” he said. “People who are hopeful take care of themselves, people who are hopeful are less stressed, and people who are hopeful have reason to be hopeful about the future.”

When people lose hope, their health declines, he said.

And people look for ways to reduce their stress, often turning to drugs and alcohol, he said.

The study found that accidental drug poisonings for middle-aged adults since the 1990s have increased by 212.3 percent in Fresno County and 163.7 percent in Kern County.

Viral hepatitis, often tied to use of injected drugs, has increased by 166.5 percent for that group in Tulare County since the 1990s.

The report cites an increase of 248 percent for drug overdoses among white men ages 25 to 34 in Kern County.

And it found that suicides by hanging, strangulation and suffocation have increased by 121 percent in the region.

Alcohol poisonings increased fifteenfold, Woolf said.

121Percent increase in suicides by hanging, strangulation and suffocation in four-county region of the Central Valley

“We call these stress-related conditions,” he said. And the deaths go beyond what can be explained by opioid and methamphetamine epidemics in the Valley counties, he said. “There are larger, psychosocial stresses in this population.”

Fresno County health officials, who had been briefed on the report, said in a written statement: “Any increase in rates of premature, preventable death are a major cause for concern. Significant and concentrated poverty (and the disadvantages in the social and physical environment that this incurs) in Fresno County and the Southern San Joaquin Valley contribute to a multitude of chronic illnesses that lead to premature death.”

And they added that it also “contributes, as well, to a sense of despair that leads to early death from self-destructive behaviors such as drug and alcohol misuse, risk taking, and suicide.”

David Pomaville, the county’s health director, and Dr. Ken Bird, the county’s health officer, said a broad coalition of people in the community is needed to address the issues.

Iton said the study reinforces the need for maintaining access to health care, especially in the areas of mental health and substance abuse.

While not specifically talking about a threatened repeal of the Affordable Care Act, Iton said: “We think this is a bad time, from a policy perspective, to be thinking about pulling health care away from people.”

But more is at stake, he said: “Our issue has been that health care is a critical part of health for people in California, but it by itself is not sufficient. We also have to have policies around education, housing, wages.”